A 10-year experience in the treatment of trigeminal neuralgia

1982 ◽  
Vol 57 (6) ◽  
pp. 757-764 ◽  
Author(s):  
Harry van Loveren ◽  
John M. Tew ◽  
Jeffrey T. Keller ◽  
Mary A. Nurre
Keyword(s):  
Trigeminal Neuralgia ◽  
Neurovascular Compression ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Significant Difference ◽  
Technical Advances ◽  
Trigeminal Root ◽  
Fine Print

✓ Of 1000 patients with classic trigeminal neuralgia who were treated during the last 10 years, 90% had an initial favorable response to medical therapy, but 75% (750 patients) failed to achieve satisfactory long-term relief. Of these, 700 patients were treated by percutaneous stereotaxic rhizotomy (PSR) and 50 were selected for posterior fossa exploration (PFE). Of the 50 patients undergoing PFE, 82% had neurovascular contact at the trigeminal root entry zone, but only 46% were judged to have had significant neurovascular compression. Exploration was negative in 16% of patients and revealed neural compression by bone in 2%. Patients with neurovascular compression were treated by microvascular decompression (MVD); all other patients with exploratory surgery underwent partial sensory rhizotomy. At 3 years after PFE, 84% of patients are pain-free. Results are excellent in 68%, good in 12%, fair in 4%; 12% had a recurrence of their neuralgia. The 700 patients treated by PSR have been followed for 6 years. Results are excellent in 61%, good in 13%, fair in 5%, and poor in 1%; 20% had a recurrence. This study indicates that there is no significant difference in results between PSR and PFE in the treatment of trigeminal neuralgia. The concept that neurovascular compression is a mechanical factor in the etiology of trigeminal neuralgia was supported, but neurovascular compression was less common than previously reported. Percutaneous stereotaxic rhizotomy is a less formidable procedure than PFE, and is easily repeated. Recent technical advances have improved the results obtained with PSR. Therefore, PSR remains the procedure of choice for the majority of patients with trigeminal neuralgia.

Dorsal root entry zone lesions to control central pain in paraplegics

1981 ◽  
Vol 55 (3) ◽  
pp. 414-419 ◽  
Author(s):  
Blaine S. Nashold ◽  
Elizabeth Bullitt
Keyword(s):  
Dorsal Root ◽  
Central Pain ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Cord Injury ◽  
Fine Print

✓ Thirteen patients with intractable long-term pain following spinal cord injury and paraplegia were treated with dorsal root entry zone lesions placed at the level just above the transection. Pain relief of 50% or more was achieved in 11 of the 13 patients, with follow-up periods ranging from 5 to 38 months. A previous report showed that central pain from brachial plexus avulsion could be relieved by dorsal root entry zone lesions, and this technique has been extended to the central pain phenomena associated with spinal trauma and paraplegia.

Diagnostic relevance of trigeminal evoked potentials following infraorbital nerve stimulation

1991 ◽  
Vol 75 (2) ◽  
pp. 244-250 ◽  
Author(s):  
Massimo Leandri ◽  
Emilio Favale
Keyword(s):  
Trigeminal Neuralgia ◽  
Infraorbital Nerve ◽  
Entry Zone ◽  
Content Type ◽  
Maxillary Nerve ◽  
Root Entry Zone ◽  
Idiopathic Trigeminal Neuralgia ◽  
Parasellar Region ◽  
Trigeminal Root ◽  
The Brain

✓ A new tool in neurophysiological exploration of the trigeminal nerve has recently been introduced. It has been demonstrated that stimulation of the infraorbital nerve trunk gives rise to very reliable scalp responses reflecting the activity of the afferent pathway between the maxillary nerve and the brain stem. The authors demonstrate that alterations of such trigeminal evoked responses fit with documented pathological processes at various locations along the trigeminal pathway (maxillary sinus, parasellar region, and within the brainstem parenchyma). They report the findings in 68 patients suffering from “idiopathic” trigeminal neuralgia. Alterations of the response were detected in 33 cases, suggesting that some damage of the nerve had taken place either at the root entry zone into the pons (23 cases) or slightly distal to it (10 cases). Such results support the hypothesis that trigeminal neuralgia may be due to a compression of the trigeminal root at the pons entry zone.

Long-term outcome after operation for trigeminal neuralgia in patients with posterior fossa tumors

1996 ◽  
Vol 84 (5) ◽  
pp. 818-825 ◽  
Author(s):  
Fred G. Barker ◽  
Peter J. Jannetta ◽  
Ramesh P. Babu ◽  
Spiros Pomonis ◽  
David J. Bissonette ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Posterior Fossa ◽  
Trigeminal Nerve ◽  
Posterior Fossa Tumors ◽  
Duration Of Symptoms ◽  
Long Term Outcome ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Fine Print

✓ During a 20-year period, 26 patients with typical symptoms of trigeminal neuralgia were found to have posterior fossa tumors at operation. These cases included 14 meningiomas, eight acoustic neurinomas, two epidermoid tumors, one angiolipoma, and one ependymoma. The median patient age was 60 years and 69% of the patients were women. Sixty-five percent of the symptoms were left sided. The median preoperative duration of symptoms was 5 years. The distribution of pain among the three divisions of the trigeminal nerve was similar to that found in patients with trigeminal neuralgia who did not have tumors; however, more divisions tended to be involved in the tumor patients. The mean postoperative follow-up period was 9 years. At operation, the root entry zone of the trigeminal nerve was examined for vascular cross-compression in 21 patients. Vessels compressing the nerve at the root entry zone were observed in all patients examined. Postoperative pain relief was frequent and long lasting. Using Kaplan—Meier methods the authors estimated excellent relief in 81% of the patients 10 years postoperatively, with partial relief in an additional 4%.

Decompression of the posterior trigeminal root in trigeminal neuralgia

1982 ◽  
Vol 57 (1) ◽  
pp. 14-17 ◽  
Author(s):  
Palle Taarnhøj
Keyword(s):  
Trigeminal Neuralgia ◽  
Content Type ◽  
Long Term Follow Up ◽  
Trigeminal Root ◽  
Suboccipital Approach ◽  
Fine Print

✓ The author presents a long-term follow-up report of his experience with decompression of the posterior trigeminal root in 350 cases. He has found that the suboccipital approach results in fewer recurrences of pain than the temporal approach.

Microvascular relations of the trigeminal nerve

1980 ◽  
Vol 52 (3) ◽  
pp. 381-386 ◽  
Author(s):  
Stephen J. Haines ◽  
Peter J. Jannetta ◽  
David S. Zorub
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Facial Pain ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Venous Compression ◽  
Trigeminal Nerve Root ◽  
Trigeminal Nerves ◽  
Fine Print

✓ The vascular relationships of the trigeminal nerve root entry zone were examined bilaterally in 20 cadavers of individuals known to be free of facial pain. Fourteen of 40 nerves made contact with an artery, but only four of these showed evidence of compression or distortion of the nerve. In addition, the vascular relationships of 40 trigeminal nerves exposed surgically for treatment of trigeminal neuralgia were studied, and 31 nerves showed compression by adjacent arteries. Venous compression was seen in four of the cadaver nerves and in eight nerves from patients with trigeminal neuralgia. These data support the hypothesis that arterial compression of the trigeminal nerve is associated with trigeminal neuralgia.

Gamma knife radiosurgery using 90 Gy for trigeminal neuralgia

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 152-154 ◽  
Author(s):  
Bradley Nicol ◽  
William F. Regine ◽  
Claire Courtney ◽  
Ali Meigooni ◽  
Michael Sanders ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Complete Relief ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Good Pain Control ◽  
Fine Print

Object. The purpose of this paper was to assess the treatment of trigeminal neuralgia (TN) with the higher than normal dose of 90 Gy. Methods. Forty-two patients with typical TN were treated over a 3-year period with gamma knife radiosurgery. Every patient received a maximum dose of 90 Gy in a single 4-mm isocenter targeted to the root entry zone of the trigeminal nerve. Thirty of 42 patients had undergone no prior treatments. The median follow-up period was 14 months (range 2–30 months). Thirty-one patients (73.8%) achieved complete relief of pain. Nine patients (21.4%) obtained good pain control. Complications were limited to increased facial paresthesia in seven patients (16.7%) and dysgeusia in four patients (9.5%). Conclusions. The authors conclude that the use of 90 Gy is a safe and effective dose for the treatment of TN.

Microvascular decompression for trigeminal neuralgia

1982 ◽  
Vol 57 (4) ◽  
pp. 487-490 ◽  
Author(s):  
Robert Breeze ◽  
Ronald J. Ignelzi
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Late Recurrence ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Early Success ◽  
Trigeminal Nerve Root ◽  
Fine Print

✓ Fifty-one consecutive patients with trigeminal neuralgia underwent 52 procedures for microvascular decompression of the trigeminal nerve root entry zone. There was an 85% early success rate; however, after a longer follow-up period, a 13% late recurrence rate was found. In all, 60% of the patients experienced some form of complication, but in only 23% was the complication persistent.

Stereotactic radiosurgery for trigeminal neuralgia: a multiinstitutional study using the gamma unit

1996 ◽  
Vol 84 (6) ◽  
pp. 940-945 ◽  
Author(s):  
Douglas Kondziolka ◽  
L. Dade Lunsford ◽  
John C. Flickinger ◽  
Ronald F. Young ◽  
Sandra Vermeulen ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Stereotactic Radiosurgery ◽  
Good Control ◽  
Dose Selection ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Fine Print

✓ A multiinstitutional study was conducted to evaluate the technique, dose-selection parameters, and results of gamma knife stereotactic radiosurgery in the management of trigeminal neuralgia. Fifty patients at five centers underwent radiosurgery performed with a single 4-mm isocenter targeted at the nerve root entry zone. Thirty-two patients had undergone prior surgery, and the mean number of procedures that had been performed was 2.8 (range 1–7). The target dose of the radiosurgery used in the current study varied from 60 to 90 Gy. The median follow-up period after radiosurgery was 18 months (range 11–36 months). Twenty-nine patients (58%) responded with excellent control (pain free), 18 (36%) obtained good control (50%–90% relief), and three (6%) experienced treatment failure. The median time to pain relief was 1 month (range 1 day–6.7 months). Responses remained consistent for up to 3 years postradiosurgery in all cases except three (6%) in which the patients had pain recurrence at 5, 7, and 10 months. At 2 years, 54% of patients were pain free and 88% had 50% to 100% relief. A maximum radiosurgical dose of 70 Gy or greater was associated with a significantly greater chance of complete pain relief (72% vs. 9%, p = 0.0003). Three patients (6%) developed increased facial paresthesia after radiosurgery, which resolved totally in one case and improved in another. No patient developed other deficits or deafferentation pain. The proximal trigeminal nerve and root entry zone, which is well defined on magnetic resonance imaging, is an appropriate anatomical target for radiosurgery. Radiosurgery using the gamma unit is an additional effective surgical approach for the management of medically or surgically refractory trigeminal neuralgia. A longer-term follow-up review is warranted.

Teflon-induced granuloma following treatment of trigeminal neuralgia by microvascular decompression

1997 ◽  
Vol 87 (3) ◽  
pp. 454-457 ◽  
Author(s):  
Ishwar C. Premsagar ◽  
Timothy Moss ◽  
Hugh B. Coakham
Keyword(s):  
Foreign Body ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Foreign Body Reaction ◽  
Inert Material ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Sensory Root ◽  
Fine Print

✓ The authors report two cases of Teflon-induced granuloma occurring as a result of microvascular decompression using Teflon wool for the treatment of trigeminal neuralgia (TN). Teflon, which is used to separate a compressing vessel from the root entry zone (REZ) of the trigeminal nerve at the brainstem, is presumed to be an inert material. In the two cases reported here, however, Teflon induced a foreign body reaction at the REZ, causing recurrence of TN. The patients' pain was cured by complete decompression or partial sensory rhizotomy of the trigeminal sensory root at reoperation. Teflon-induced granuloma has occurred in 1.3% of the authors' series of 155 patients with TN treated using microvascular decompression. Recommendations for avoiding this complication are offered.

Trigeminal neuralgia caused by microarteriovenous malformations of the trigeminal nerve root entry zone: symptomatic relief following complete excision of the lesion with nerve root preservation

2002 ◽  
Vol 97 (4) ◽  
pp. 874-880 ◽  
Author(s):  
Richard J. Edwards ◽  
Yvonne Clarke ◽  
Shelley A. Renowden ◽  
Hugh B. Coakham
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Nerve Root ◽  
Preoperative Imaging ◽  
Posterior Fossa Surgery ◽  
Entry Zone ◽  
Content Type ◽  
Root Entry Zone ◽  
Trigeminal Nerve Root ◽  
Fine Print

Object. Within a series of 341 consecutive patients who underwent posterior fossa surgery for trigeminal neuralgia (TN), in five the cause was found to be a microarteriovenous malformation (micro-AVM) located in the region of the trigeminal nerve root entry zone (REZ). The surgical management and clinical outcomes of these cases are presented. Methods. Patients were identified from a prospectively collected database of all cases of TN treated at one institution between 1980 and 2000. Presentation was clinically indistinguishable from TN caused by vascular compression. Preoperative imaging, including computerized tomography scanning (two cases) and magnetic resonance (MR) imaging and MR angiography (three cases), failed to demonstrate an AVM except for one case in which multiple abnormal vessels were identified in the trigeminal REZ on an MR image obtained using a 1.5-tesla magnet. All patients underwent a standard retromastoid craniotomy. In all cases a small AVM embedded in the trigeminal REZ was identified and completely excised, with preservation of the trigeminal nerve. All patients experienced immediate relief of pain following surgery. Postoperatively, in one patient a small pontine hematoma developed, resulting in permanent trigeminal nerve anesthesia in the V2 and V3 divisions. All patients were free from pain at a mean follow-up period of 30 months. Conclusions. These rare lesions are usually angiographically occult, but may sometimes be identifiable on high-resolution MR images. Total microsurgical resection with nerve preservation is possible, although operative complications are relatively common, reflecting the intimate association between these lesions and the pons. Complete resection is advised not only for symptom relief, but also to eliminate the theoretical risk of pontine hemorrhage.

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